Healthcare Provider Details

I. General information

NPI: 1720124696
Provider Name (Legal Business Name): SYLVIAS HOME MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W CHURCH ST
BUNKIE LA
71322-1717
US

IV. Provider business mailing address

PO BOX 301 104 W. CHURCH STREET
BUNKIE LA
71322-0301
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-2518
  • Fax: 318-346-2546
Mailing address:
  • Phone: 318-346-2518
  • Fax: 318-346-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: DARLENE ST. ROMAIN
Title or Position: OWNER
Credential:
Phone: 318-346-2540